Brain Trauma

Posted 07.30.08

NOVA scienceNOW

Knocks to the head may seem funny in cartoons, sports replays, and YouTube videos, but even minor head injuries often lead to serious concussions. A concussion may leave no trace on a conventional MRI scan yet cause permanent memory loss, attention problems, and depression. NOVA scienceNOW investigates promising new leads in understanding this puzzling condition, which affects millions of people in the U.S., including many high-school and college athletes who suffer concussions yet are encouraged to return to the playing field.

Transcript

BRAIN TRAUMA

PBS Airdate: July 30, 2008

NEIL
DeGRASSE TYSON: Getting hit on the
head is pretty much a guaranteed laugh in the world of cartoons, TV shows and
movies. But in the real world, it's not so funny. And as correspondent John
Torres reports, these days, we're finding out that even a seemingly minor head
injury can cause a lot more damage than we ever thought.

JOHN
TORRES: Reed Snyderman is 17. A high school junior, he
plays varsity lacrosse and he's the U.S. Junior Olympic champion in freestyle
skiing.

It
was the last day of spring break, in 2008, when his trouble started.

REED
SNYDERMAN: I was at the U.S. Nationals the
end of, at the end of March. And I landed my top air, which was a back-flip
iron cross. I was really aggressive, like, charging it, because I really wanted
to go for it, you know? And I ended up just kind of catching my edge and kind
of flipping and hitting my head and then being really bewildered and not really
knowing what was going on.

SARAH
SNYDERMAN (Reed Snyderman's Mother):
His coach went over to him first and came
back to me and said that he thought he was fine, except he might have a mild
concussion.

JOHN
TORRES: But Reed was not fine at all.

REED
SNYDERMAN: I was really out of it. Everything's
out of sync. It was really difficult for my brain to maintain a train of
thought. It was definitely scary.

JOHN
TORRES: Almost 4,000,000 athletes, boys and girls, suffer
concussions every year. Many of them recover quickly. And a bang on the head is
often considered just part of the game. You shake it off, and get back to the
field as soon as possible. But for 20 percent of patients diagnosed with a
concussion, recovery isn't so easy, because even when it's mild, a concussion
is a traumatic brain injury.

JAM GHAJAR: If you look at traumatic brain injury, it is the
number one cause of death and disability in young people.

JOHN
TORRES: Jam Ghajar is a neurosurgeon at Weill Cornell
Medical College in New York, and an international expert in brain injuries.

JAM GHAJAR: Ninety percent of traumatic brain injury is
concussion. And how many numbers are we talking about? There are millions.

JOHN
TORRES: But concussions are difficult to diagnose. They
generally don't show up on a standard M.R.I., like the one I'm having now. So
even if a patient has symptoms, understanding why is complicated.

Take
a look at my M.R.I. compared to the M.R.I. of a concussion patient.

JOHN
TORRES: M.R.I.s produce images of gray matter, cells
called neurons and their connections, which make up most of the surface of the
brain. Gray matter is organized into specific regions, which control functions
like memory, speech, movement and coordination.

But
a concussion doesn't usually do much damage to the gray matter. So
now neurologists are searching for clues deeper within the brain, in the white
matter.

MARILYN
KRAUS (University of Illinois at Chicago):
The white matter makes up the sort of
cables or connections between the lobes or the sections of the brain.

JOHN
TORRES: Those white matter connections are like telephone
trunk lines. They bundle nerve cells from different areas of the brain into
networks, which work together to produce and regulate thoughts and actions.

But
if the white matter is damaged by a concussion, the connections could get
disrupted, in theory, at least. Until recently, though, it was very difficult
to see white matter on an M.R.I.

MARILYN
KRAUS: To be able to really quantify and
qualify the integrity of the white matter, you need to go to a specialized
sequence like the D.T.I., or diffusion tensor imaging.

JOHN
TORRES: D.T.I., or diffusion tensor imaging, is a new way
to bring white matter out of the shadows, using advanced software to get more
detailed information from an M.R.I. image.

DEBORAH
LITTLE (University of Illinois at Chicago):
When we bring up the D.T.I., you then can
really clearly see where the white matter is and where the gray matter is,
because, on this, white is white, gray matter is gray.

JOHN
TORRES: It's not only the color that's important. White
matter helps diffuse water through brain cells, and that may be an important
clue to what goes wrong in concussions.

DEBORAH
LITTLE: And so, with the D.T.I., all we're
doing is looking at where water is, pretty much.

JOHN
TORRES: So if the water is not flowing well, that tells
you that there is some...

DEBORAH
LITTLE: If you have a leak in the pipe, we're
going to be able to pick that up with the D.T.I. If you compare the left and
the right, you can see these two tracts clearly, here. But you can see, on this,
you have the one on the outside, and the one on the inside is disrupted.

JOHN
TORRES: One part of the brain can't talk to the other
side of the brain, because it can't make it through that area.

JOHN
TORRES: Jam Ghajar agrees. His theory is that tiny tears
in the white matter, caused by a concussion, disrupt the brain's natural
timing, like a telephone conversation gone wrong.

JAM GHAJAR: One way for a normal person to feel like somebody
with a concussion is to think of a cell phone conversation. Normally when you
talk on the cell phone, you talk, the other person talks, you go back and forth,
and it's smooth, but then, (silence), like my voice right there. You were
expecting my voice to come in. It didn't come in, and you went...you got an
error signal.

JOHN
TORRES: Ghajar's theory is that microscopic tears in the
white matter cause these error signals. They disrupt communication between
different parts of the brain responsible for helping us to pay attention and
remember what's going on around us.

JAM GHAJAR: There are populations of cells that communicate with
each other and produce brain function. If you disrupt the connections between
these areas, you disrupt attention and memory.

JOHN
TORRES: To test this idea, I'm participating in an
experiment Ghajar devised to measure a person's ability to pay attention.

This
device records how well my eyes stay in sync with a moving target.

So
these cameras are watching where my eyes are moving?

TECHNICIAN: Yes.

JAM GHAJAR: We picked eye movements in terms of following a
predictable target. And you can't drive your eyes in a circle automatically.
You have to pay attention to the target when it's going around.

JOHN
TORRES: For most people, this test is easy. My eyes
follow the target with no break in the cycle. But for someone who has symptoms
after a concussion, it's a different story.

Ten
years ago, artist Ann Schenpf suffered a concussion in a car accident. Even
after intense therapy, she still has problems with speech, memory and
attention.

ANN SCHNEPF (Concussion Patient): The first day that I went into my studio, I looked
at my materials, and I couldn't figure out what to do with them. Like, I would
pick up my...excuse me, I'm having trouble with words.

JOHN
TORRES: Words for familiar things don't always come
easily.

Like
the paint.

ANN SCHNEPF: The
paint, yeah. Like, I didn't remember what I did with it, even though I looked
around my studio, and I could see my current painting that I was working on. So
I turned around, and I walked out. I'm still, 10 years later, having a lot of
those difficulties.

JOHN
TORRES: When Ann tries the eye tracking test, it's a
struggle.

JAM GHAJAR: What's happening with her is she's constantly having
to start over again, and she's losing her train of thought. So here's a very
predictable target. It's going around like this. My brain should be able to
know it's going around like this and where the dot's going to be next. A
head-injured patient is just wobbly all over it. They're trying to synchronize
the dot. Their timing is off, and as a consequence, they've got this
variability, which is directly proportional to how good their attention is.

RORY MORTON (Buckingham Browne & Nichols School): Good hit, good hit.

JOHN
TORRES: For young athletes, problems with attention after
a concussion can go way beyond the playing field.

REED
SNYDERMAN: Definitely during school, I
would like, I would lose the entire class, and I would lose the entire
discussion in my classes. And math was impossible for that week, and I'm
usually a really strong math student, so it was really strange.

RORY MORTON: Reed,
that stick belongs below the shoulders...

Someone
who's had a concussion may look like they should be able to participate. But
they're not really aware of what they're doing at all. So that's a scary
thought.

JOHN
TORRES: But the most scary thought is sending a student
who's had a concussion back into the game. This can happen, because there's no
way to objectively diagnose concussions on the sidelines, and young athletes
most often don't want to be benched.

But
what if there were a tool to quickly and accurately assess if a brain injury
has taken place? That's Jam Ghajar's next goal. He's developing a small,
portable version of the eye tracking system I tried in the lab. Ann helped
demonstrate how it might work.

JAM GHAJAR: So it's like a pair of regular glasses, and I'll
cinch it up here a little bit. How's that feel?

ANN SCHNEPF: Comfortable.

JAM GHAJAR: Good. Okay.

JOHN
TORRES: The same moving circle is projected directly on
to the lens of this specially designed pair of glasses. Then a miniature camera
records how well the eyes follow it. It's a quick way to tell if a concussion
has taken place, impairing the brain's ability to pay attention to what's
happening on the field.

RORY MORTON: Let's
go, let's go.

JOHN
TORRES: And that's an essential piece of information,
because an athlete who's had one concussion is at high risk for another.

JAM GHAJAR: The person who's got poor attention, you don't want
to send them back into play. Send them back in, they are unable to pay
attention, and they get another injury. And you keep on adding those
concussions together, then you see things like dementia and so on later in
life.

JOHN
TORRES: Ghajar's theory is still being tested. But the
potential to diagnose concussions quickly and accurately is an appealing idea
to Reed's coach.

RORY MORTON: It
would just take all of the risk out of the equation. Something that is able to
confirm a trauma to the brain, that takes the conjecture out of everyone's
hands and says, "This is what we have to do."

JOHN
TORRES: Six weeks after his concussion, Reed has made a
full recovery. But the experience stays with him every time he heads onto the
field or the slopes.

REED
SNYDERMAN: I think a concussion is one of
the scariest injuries that you can get. Like, I mean, when you break your arm,
you're still you. You still can think, you still can, you know, you can still
function fine. But when you hurt your brain, even when it's minor, even when it's
not major, it's like you're not you for awhile, and that's definitely
frightening.

BBC Gallery
JPL-Caltech
The Alan Mason Chesney
Medical Archives of The Johns Hopkins Medical Institutions
NASA
Plimpton
Collection, Rare Book and Manuscript Library, Columbia University
Sveriges Television
Texas A&M University
University of Arizona
University of
Nebraska State Museum

This material is based upon work
supported by the National Science Foundation under Grant No. 0638931. Any
opinions, findings, and conclusions or recommendations expressed in this
material are those of the author(s) and do not necessarily reflect the views of
the National Science Foundation.

PBS: The Secret Life of the Brain
www.pbs.org/wnet/brain/index.html
This page provides a look at the way our brains change from infancy through adulthood, plus a 3-D tour of the brain's anatomy, optical illusions, and more.

Books

Head Cases: Stories of Brain Injury and Its Aftermath
by Michael Paul Mason. Farrar, Straus, and Giroux, 2008.